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TRANSCRIPT

Chat with John Donnelly

On Monday, January 27, Globe reporter John Donnelly chatted with Boston.com users about the Lives Lost series and issues in world health.

John Donnelly
(Moderator)
12:33PM

Hi. This is John Donnelly of the Boston Globe. I welcome any questions out there

bla12:37PM

I hope this doesn't seem too bizarre/inappropriate, but I had actually been thinking of going to Guatemala as a tourist. I had a friend who visited there last year and described it as a beautiful place, appropriate for travel. I

John Donnelly
(Moderator)
12:39PM

It's not inappropriate at all. I think Guatemala would be a great place to go visit _ especially with a deeper understanding of what's around, i.e., the poverty, and how the health system works. You may want to stop in on a health clinic there and talk with doctors and nurses about what they need. I think that would add great interest to any trip.

Kelly12:39PM

Hi John, first I want to say thanks for bringing these issues to light for Globe readers. I want to ask why you think Americans -- in particular -- are unaware of the lack of access to basic healthcare around the world. Thanks.

John Donnelly
(Moderator)
12:42PM

Hi Kelly. That's a good question. I think there are a lot of reasons. One is that the US government does not focus much on it, the media doesn't give it much attention, and health issues generally have been dominated by AIDS. And AIDS is perceived by most journalists as an old, hopeless story. I don't see it that way at all, but that's the general impression.

bla12:43PM

Will you keep in touch with any of the people that you interviewed for this report? I've always wondered if reporters are able to do that since you meet so many people.

John Donnelly
(Moderator)
12:47PM

Yes, I will. I was just on the Connection on WBUR, and one of the guests was Kingsley Magomero, a doctor at Lilongwe Central Hospital. He gave a rundown of his day today, and it was haunting _ 53 admissions, 15 new patients, 6 dead over the weekend, including two who died without being seen by a doctor. Some of the people whom we met have died _ three in Malawi, in fact. So, not to be melodramatic about it, it's important to remember them, especially when we think of new stories to write.

johnsc12:47PM

Great series. The problem of lack of good health care services in many parts of the world seems so large and intractable. What do you see as potential, practical solutions?

John Donnelly
(Moderator)
12:50PM

Thanks for the question. I first see a need for a global vision. Someone needs to give a clear statement of the needs around the world. It must come from someone such as Kofi Annan. Then there needs to be detailed country plans that list the priorities that the countries will tackle. NGOs on a country by country level need to coordinate better. Global health veterans need to scour communities will the specific idea of looking for the best bets to replicate and scale up programs. And the media needs to begin focusing on solutions _ because that's part of the reality, and that will dispel the pervailing mood of hopelessness that now exists.

Bruno12:51PM

John, I take it from your stories each day that you cover the State Department. How active is the current administration in dealing with healthcare in third-world countries than previous administrations? And does President Bush's promise of increasing foreign aid give any more hope to the World Health Organization?

John Donnelly
(Moderator)
12:52PM

Bruno: I cover foreign affairs broadly, and that includes State, Defense, and intelligence agencies. I think this administration, particularly Colin Powell, have said some very powerful things (Powell said AIDS is a larger problem than terrorism), but their deeds haven't matched their words. Something may happen out of the State of the Union speech. But still it is likely to focus almost exclusively on AIDS _ not the broad-based approach that ultimately will be needed

Kelly12:52PM

I agree with you -- Americans need to understand that lack of access to healthcare can -- and clearly will in the case of Africa -- dramatically impact the economic, political and social environment and alter the existing infrastructure on the continent. Do you think funding and access are the two most important things to get healthcare to people around the world and should the US govenrment take the lead?

John Donnelly
(Moderator)
12:56PM

Kelly: Funding and access are key. But I think the infrastructure also needs much work. In our series, we point out that Cambodian doctors are paid incredibly low salaries, the same with Malawian doctors. They need to be paid more. That's just one of the solvable problems, of course. That doesn't resolve the issue of corruption.

Rembrandt12:56PM

I know Bill Gates, among others, has given large amounts of private money to worldwide health causes. In your opinion does this kind of philantropy have much of a role in solving these problems, or is it being done for the PR value?

John Donnelly
(Moderator)
12:59PM

Rembrandt: Good question. He was asked this last week in a conference call with reporters. I don't think it's true, and I ultimately think it's a non-issue: who else is spending $800 million a year to help save the lives of poor people around the world? I think that's the lense through which to see it. No matter the motive, look at the possible results, and the absence of other extraordinarily wealthy people following his lead. You know, Gates jumped into global health after researching for more than a year an area of philanthropy. He was blown away that so little was being done in global health

jonnieonthespot12:59PM

We need to stop giving free condoms to African countries. Give it up, it just doesn't work. They need to change their cultural mood that views women merely as conquests and need to understand that rape is WRONG. education is a much better solution; and the abstinence message is what is needed as well. Let's not forget the thousands of Christian missionaries in Africa who are not forgetting 'the least of these'. They do thankless work every day and sometimes die for it, and get vilified in the U.S. and European presses as 'thoughtless proselytizers who don't understand African culture'. Baloney. They are a godsend to Africa.

John Donnelly
(Moderator)
01:01PM

Abstinence messages work _ only to a point. I think that people who have studied these things for years, including some contrarians, have found that a combination of messages works best.

penelope01:04PM

John: Congratulations on finally getting such a wonderful, long section dedicated to these issues. I was interested to hear yours and Jeff Sachs' comments earlier about the importance of systems--how so many are lacking in so many countries. While USAID is putting some money toward these issues, it's also clear that funders look for quick fixes, which most systemic issues are not! Do you think The Gates Foundation and others are prepared to look more holistically at these issues?

John Donnelly
(Moderator)
01:08PM

Hi Penelope: That's a great question. I think it's possible that Gates and others will evolve these way. They are not there yet. As you know, I'm sure, everyone wants to invest in a building, or a specific disease, but they don't want to pay for nurses salaries every year. I think then that in order to attack this holistically you need some visionary saying this is the way it has to be, and forcing coalitions of governments, NGOs, faith-based groups to work together toward that end. Do you think that's possible?

Evan01:08PM

Is it an overstatement that AIDS could wipe out the population of Africa within 20 years?

John Donnelly
(Moderator)
01:11PM

People who predict the future of AIDS have almost all been wrong. The CIA's think tank has come closest in the past. And what they say now is that Nigeria and Ethiopia in seven years or so will see rates approaching those in southern Africa, i.e., 25-40 percent HIV-infection rates. But what does happens to a country that has 30-35 percent infection rates for a decade? What happens to the armed forces? What happens to the orphans, who number in the millions? Imagine that. I thought of that everytime I stopped at a light in Lusaka: swarms of boys and girls who live on the streets came knocking on our windows. Multiply that by 10, and ask whether society holds together.

healthyguy01:12PM

What is your educational background? I am very interested in health, primarily urban health. I have an undergrad degree in Biology. What do you recommend? Are there jobs out there for people with Master in Public Health? Epidimiology?

John Donnelly
(Moderator)
01:13PM

Healthyguy: Biology is a great base. Look into public health programs. There's a great future there, I think. I've been interested in health issues for more than a decade, after visiting Paul Farmer's very successful programs in Cange, Haiti, in the early 1990s. After seeing how you could bring great health care to one of the poorest places on earth, I was hooked.

jonnieonthespot01:13PM

Sorry, disagree, the condom message is WRONG. It has been used for a while now and AIDS is spreading like the plague in Africa. When will we ever learn? Abstinence is the key, relations between a married man and a married woman (in any culture) is the key to a good health system. Once this message gets out, you'd be surprised at the difference it will make! I'm not saying that other 'programs' aren't necessary, but we seriously need to consider whether dumping truckloads of free condoms at the gates of AFrican countries is the answer. I think not.

jonnieonthespot01:14PM

By the way, your suggestion of Kofi Annan as 'Global Healthspokesperson' is fairly ridiculous. The man can't stand up to Saddam whatsoever and you want him to solve the world's health problems? He has no spine, this is an issue that needs serious LEADERSHIP.

John Donnelly
(Moderator)
01:17PM

Jonnieonthespot: Abstinence is working better now than it did five years ago in many settings _ because the Africians I've met, especially young African women, are very wise, and they see the consequences of unprotected sex. As for Kofi Annan, I didn't necessarily mean it was up to him, but rather someone who has that kind of stature. I know what you mean about 1998 in Baghdad _ I was there _ but I don't think you want to judge him solely on that performance.

healthyguy01:17PM

Sorry but another question: What programs do you recommend for foreign civil service, other than the Peace Corps?

John Donnelly
(Moderator)
01:18PM

Healthyguy: You could look into being a diplomat, and take the State Department's annual exams. You could also hook up with one of dozens of great NGOs. They won't pay much, but some of them, I would think, allow for some of the most rewarding work possible.

penelope01:19PM

unfortunately, I don't know who in the world would be visionary enough and high profile enough to lead the world to look at the issues holistically and over the long term. Jeff Sachs is trying. Bill Gates certainly has the profile and commitement--but as you say, isn't quite looking holistically yet. Can anyone bring people together, force the coalitions, as you write? Has anyone, ever? Churchill perhaps. I suppose things would have to get much worse and more dire for leaders (or the general public, for that matter) in the US and developed countries, or even multilateral agencies like the WHO, to set aside individual differences--and, lets name it, politics (including the narrow politics and sole approach of people like jonnieonthespot) to band together to solve the problems long term. (which isn't to say that those of us working the on the issue shouldn't keep trying to make things better, using all the approaches that work, and trying to build sustainability as we can.)

John Donnelly
(Moderator)
01:21PM

Penelope: Well, if Colin Powell believes in what he says, why isn't he the person? I've been continually amazing over the last two years why other countries or other wealthy foundations or individuals didn't take the lead. Think of what's in it for them, besides the moral and humanitarian high ground. They would be recognized in history.

Evan01:21PM

Dear jonnie: Abstinence is a nice thought, but let's also live in the real world. Sex will happen regardless so let's think of more concrete solutions. It reminds me of the "Say no to drugs" campaign, well duh, gee I never thought of that!

penelope01:22PM

healthguy: if you're based here in Boston, there are quite a few agencies that work in international public health where you might want to look. I suggest you visit the websites of John Snow, Inc (jsi.com), Pathfinder International (pathfind.org), oxfam usa and Management Sciences for Health (msh.org). It's all a matter of being in the right place at the right time, but its worth making contact.

John Donnelly
(Moderator)
01:23PM

Evan: I agree to some extent with the comparison between the abstinence and say no to drugs. Still, though, the death rates are playing some role in delaying what's called sexual onset _ the age of first intercourse.

Afreaka01:23PM

I heard something (at a U2 concert no less) that AIDS medicine must be taken on a strict time-frame and that the medicine won't work if it isn't taken at appropriate time intervals. Since many Africans don't have watches, they would be unable to take the right medicines at the right times and the medicine would be wasted. Is this true?

John Donnelly
(Moderator)
01:25PM

Afreaka: Well, that's what Andrew Natsios, the head of USAID, said more than a year ago, and it got him immediately into trouble _ because it showed he didn't know about more simple drug regimins. It's treatment that can be take at sunrise, or sunset. No watch needed.

Mari Achi01:25PM

John, what are some of the other countries that the Globe will examine in the future?

John Donnelly
(Moderator)
01:26PM

Mari Achi: Good question. We haven't decided. We want to focus on programs that are the best of their kind and offer an example to the rest of the world. We're open to any suggestions. You and others can do it here, or send to my email: donnelly@globe.com

penelope01:27PM

wow. Maybe Colin Powell could do it--but I'm not sure his own administration listens to him (millions of others, do, though). John, you've given cynical old me me hope! Let's start a campaign! The Globe section yesterday is a terrific first step! Thanks again for your attention to these issues.

jonnieonthespot01:27PM

What work is being done to try to help third world countries understand that repressive, corrupt regimes hurt their people? Can't we see how Saddam Hussein has ruined the futures of many Iraqi children? Yes, the U.S. healthcare system has its disadvantages and problems but my goodness I think we are doing a good job with our children. Corrupt, repressive government = poor health care, unemployment, disease, famine, etc. Once we get rid of Saddam, the Iraqi children will have a future once again. I know they are wonderful people who have been victimized by a complete wacko. These repressive leaders are probably hurting health care efforts around the world more than anything else. Would you not agree. Thank you by the way for the answers to my questions.

John Donnelly
(Moderator)
01:30PM

Jonnieonthespot: Good question. You know what I think will happen? I think that different organizations such as the Global Fund to fight AIDS, TB and Malaria won't be giving to countries where they can't follow the money trail. That creates an interesting and painful dynamic. First, health problems need to be holistically addressed. Then, countries that are absent from this aid will start to feel pressure. You can see it now in the polio eradication campaign: No country wants to be the last place to record a polio case.

Mari Achi01:30PM

What about a story on preventable diseases in the US? Seems there are people here worth talking about even though it would obviously be smaller in scope. We have our own problems, right?

John Donnelly
(Moderator)
01:33PM

Mari Achi: I'm glad someone raised this. We briefly talked about including a section on the US in the special section. We decided against it because it didn't seem right to equate the burden of disease in the US with, say, the burden of disease in Malawi. There are great problems here, but they are so miniscule compared to the poor world. We believed that's where the focus should remain for the project _ on a country that spends $7 per person on health (Malawi), vs. a country that spends $4,000 per person (US).

penelope01:33PM

Sorry, jonnie, your equation does not necessarily compute--take a look at Cuba sometime. while many would say they have a repressive regime, their healthcare outcomes are better than in the US--their child survival rates are higher, more children are immunized, etc.

John Donnelly
(Moderator)
01:36PM

Thank you to everyone out there. I'm going to sign off now. If you have other questions, send them to my email, donnelly@globe.com